Apply Now AmeriCapital Direct Application AmeriCapital Direct Application Is your Entity a Corporation? Yes No Is your Entity an LLC? Yes No Is your Entity a Sole Proprietorship? Yes No Is your Entity an LP? Yes No Is your Entity an LLP? Yes No Is your Entity a Partnership? Yes No Is your Entity a Prof. LLC? Yes No Is your Entity a Prof. Corporation? Yes No Is your Entity a Non-Profit? Yes No State of Incorporation Federal Tax ID/BIN: Number of Locations Number of Employees Business Legal Name: DBA: Business Physical Address: City: State: Zip: Business Mailing Address (If Different): City: State: Zip: Business Phone Number: Fax Number: Business Email: * Are you a Retail Business? Yes No Are you a Wholesale Business? Yes No Are you a Service Business? Yes No Are you a Lodging Business? Yes No Are you a Manufacturing business? Yes No Are you a Healthcare Business? Yes No If other business, list here: Business Established Date (mm/yy): Length of Ownership (Years): Length of Ownership (Months): Products/Services Sold: Total Monthly Sales Monthly Credit Card Sales: Seasonal Business? Yes No Peak Sales Months: Owner/Officer Name(1): Social Security No.(1): Date of Birth(1): Home Address (include Street, City, State/Zip): Title(1): Ownership %(1): How Long at This Address(1): Home Phone #(1): Mobile Phone #(1): Email Address(1) Owner/Officer Name(2): Social Security No.(2): Date of Birth(2): Home Address (include Street, City, State/Zip): Title(2): Ownership %(2): How Long at This Address(2): Home Phone #(2): Mobile Phone #(2): Email Address(2) Landlord/Mortgage Company Name and Contact Person: Landlord/Mortgage Phone Number: Time Remaining on Lease/Mortgage(Years): Time Remaining on Lease/Mortgage(Months): What Type of Property? Owned Leased Approximate Sq. Feet: Monthly Lease/Mortgage Payment: Lease Start Date (mm/yy): Bank Name: Contact Name: Phone Number: Vendor Name(1): Contact Name(1): Phone Number(1): Vendor Name(2): Contact Name(2): Phone Number(2): Is your Business for Sale? Yes No If Yes, explain: Have you ever filed for Bankruptcy? Yes No If Yes, explain: Do you have any federal or state tax liens? Yes No If Yes, explain: Do you have an outstanding merchant cash advance(s) or short-term business loan(s)? Yes No If Yes, what is the company name(s) and current balance(s): Are you current with your business property lease/mortgage? Yes No If no, by how many months: Amount Requested: Intended Use of Funds: 1st Owner/Officer Signature: 2nd Owner/Officer Signature: Date * Submit
